Maximising patient throughput using discrete-event simulation

As the National Health Service (NHS) of England continues to face tighter cost saving and utilisation government set targets, finding the optimum between costs, patient waiting times, utilisation of resources, and user satisfaction is increasingly challenging. Patient scheduling is a subject which has been extensively covered in the literature, with many previous studies offering solutions to optimise the patient schedule for a given metric. However, few analyse a large range of metrics pertinent to the NHS. The tool presented in this paper provides a discrete-event simulation tool for analysing a range of patient schedules across nine metrics, including: patient waiting, clinic room utilisation, waiting room utilisation, staff hub utilisation, clinician utilisation, patient facing time, clinic over-run, post-clinic waiting, and post-clinic patients still being examined. This allows clinic managers to analyse a number of scheduling solutions to find the optimum schedule for their department by comparing the metrics and selecting their preferred schedule. Also provided is an analysis of the impact of variations in appointment durations and their impact on how a simulation tool provides results. This analysis highlights the need for multiple simulation runs to reduce the impact of non-representative results from the final schedule analysis

Maximising patient throughput using discrete-event simulation

As the National Health Service (NHS) of England continues to face tighter cost saving and utilisation government set targets, finding the optimum between costs, patient waiting times, utilisation of resources, and user satisfaction is increasingly challenging. Patient scheduling is a subject which has been extensively covered in the literature, with many previous studies offering solutions to optimise the patient schedule for a given metric. However, few analyse a large range of metrics pertinent to the NHS. The tool presented in this paper provides a discrete-event simulation tool for analysing a range of patient schedules across nine metrics, including: patient waiting, clinic room utilisation, waiting room utilisation, staff hub utilisation, clinician utilisation, patient facing time, clinic over-run, post-clinic waiting, and post-clinic patients still being examined. This allows clinic managers to analyse a number of scheduling solutions to find the optimum schedule for their department by comparing the metrics and selecting their preferred schedule. Also provided is an analysis of the impact of variations in appointment durations and their impact on how a simulation tool provides results. This analysis highlights the need for multiple simulation runs to reduce the impact of non-representative results from the final schedule analysis

Business Process Management for optimizing clinical processes: A systematic literature review

Business Process Management is a new strategy for process management that is having a major impact today. Mainly, its use is focused on the industrial, services, and business sector. However, in recent years, it has begun to apply for optimizing clinical processes. So far, no studies that evaluate its true impact on the healthcare sector have been found. This systematic review aims to assess the results of the application of Business Process Management methodology on clinical processes, analyzing whether it can become a useful tool to improve the effectiveness and quality of processes. We conducted a systematic literature review using ScienceDirect, Web of Science, Scopus, PubMed, and Springer databases. After the electronic search process in different databases, 18 articles met the pre-established requirements. The findings support the use of Business Process Management as an effective methodology to optimize clinical processes. Business Process Management has proven to be a feasible and useful methodology to design and optimize clinical processes, as well as to automate tasks. However, a more comprehensive follow-up of this methodology, better technological support, and greater involvement of all the clinical staff are factors that play a key role for the development of its true potential.This work was supported by the Ministerio de Economía y Competitividad of the Spanish Government (ref. TIN2014-53067-C3-1-R) and co-financed by FEDER

Improvement of the portuguese breast cancer screening through process modelling (BPM)

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceBreast cancer is a malignant epithelial neoplasm with high incidence and mortality in women. Focusing the clinical performance on screening processes has proven to be the way to improve morbidity and mortality statistics of this recognized public health problem. Business process management (BPM) is a management field that improves and analyzes business processes according to organizations’ strategies. BPM may help manage patient and information flow, improving waiting time in healthcare delivery while integrating healthcare processes with IT. The early diagnosis of breast cancer is of great importance since it will enable more conservative treatments and a longer disease-free survival. Organized oncology screenings programs, with all elements properly prepared, revealed to be more efficient than the opportunistic screenings. The aim of this study is to identify and model BPM processes for the healthcare sector, namely, for the breast cancer screening in Portugal. To achieve this goal, the main processes were identified and new frameworks were proposed and validated through individual interviews with experts. In this study was concluded that BPM techniques can be applied to the healthcare. Through the application of these techniques it was possible to identify the main issues within the organized breast cancer screening and suggest changes to it. These changes focus on reducing the time of the process, improving its efficiency and offering greater support to the health user

Business Process Simulation: A Systematic Literature Review

Business process simulation marks an essential Business Process Management technique for analysing business processes and for reasoning about process improvement. Despite its importance, literature is lacking a comprehensive, updated overview of research contributions to the field of business process simulation. In this systematic literature review, we assess the present state of research on business process simulation including prior work between 1990 and 2016. Results reported in the present study assist in advancing the discussion on future research on business process simulation by compiling and analysing prior work. The present literature review focuses on prior research involving conceptual business process models, e.g., BPMN models, with a graphical model representation as a starting point for business process simulation and excludes other foundations to build simulation models

A Process Modelling Framework Based on Point Interval Temporal Logic with an Application to Modelling Patient Flows

This thesis considers an application of a temporal theory to describe and model the patient journey in the hospital accident and emergency (A&E) department. The aim is to introduce a generic but dynamic method applied to any setting, including healthcare. Constructing a consistent process model can be instrumental in streamlining healthcare issues. Current process modelling techniques used in healthcare such as flowcharts, unified modelling language activity diagram (UML AD), and business process modelling notation (BPMN) are intuitive and imprecise. They cannot fully capture the complexities of the types of activities and the full extent of temporal constraints to an extent where one could reason about the flows. Formal approaches such as Petri have also been reviewed to investigate their applicability to the healthcare domain to model processes. Additionally, to schedule patient flows, current modelling standards do not offer any formal mechanism, so healthcare relies on critical path method (CPM) and program evaluation review technique (PERT), that also have limitations, i.e. finish-start barrier. It is imperative to specify the temporal constraints between the start and/or end of a process, e.g., the beginning of a process A precedes the start (or end) of a process B. However, these approaches failed to provide us with a mechanism for handling these temporal situations. If provided, a formal representation can assist in effective knowledge representation and quality enhancement concerning a process. Also, it would help in uncovering complexities of a system and assist in modelling it in a consistent way which is not possible with the existing modelling techniques. The above issues are addressed in this thesis by proposing a framework that would provide a knowledge base to model patient flows for accurate representation based on point interval temporal logic (PITL) that treats point and interval as primitives. These objects would constitute the knowledge base for the formal description of a system. With the aid of the inference mechanism of the temporal theory presented here, exhaustive temporal constraints derived from the proposed axiomatic system’ components serves as a knowledge base. The proposed methodological framework would adopt a model-theoretic approach in which a theory is developed and considered as a model while the corresponding instance is considered as its application. Using this approach would assist in identifying core components of the system and their precise operation representing a real-life domain deemed suitable to the process modelling issues specified in this thesis. Thus, I have evaluated the modelling standards for their most-used terminologies and constructs to identify their key components. It will also assist in the generalisation of the critical terms (of process modelling standards) based on their ontology. A set of generalised terms proposed would serve as an enumeration of the theory and subsume the core modelling elements of the process modelling standards. The catalogue presents a knowledge base for the business and healthcare domains, and its components are formally defined (semantics). Furthermore, a resolution theorem-proof is used to show the structural features of the theory (model) to establish it is sound and complete. After establishing that the theory is sound and complete, the next step is to provide the instantiation of the theory. This is achieved by mapping the core components of the theory to their corresponding instances. Additionally, a formal graphical tool termed as point graph (PG) is used to visualise the cases of the proposed axiomatic system. PG facilitates in modelling, and scheduling patient flows and enables analysing existing models for possible inaccuracies and inconsistencies supported by a reasoning mechanism based on PITL. Following that, a transformation is developed to map the core modelling components of the standards into the extended PG (PG*) based on the semantics presented by the axiomatic system. A real-life case (from the King’s College hospital accident and emergency (A&E) department’s trauma patient pathway) is considered to validate the framework. It is divided into three patient flows to depict the journey of a patient with significant trauma, arriving at A&E, undergoing a procedure and subsequently discharged. Their staff relied upon the UML-AD and BPMN to model the patient flows. An evaluation of their representation is presented to show the shortfalls of the modelling standards to model patient flows. The last step is to model these patient flows using the developed approach, which is supported by enhanced reasoning and scheduling

Magneettikuvauksen prosessianalyysi – Case: Mehiläinen NEO

Organisaation toiminnan kehittämiseksi sen on jatkuvasti seurattava ja arvioitava toimin-taansa. Prosessijohtaminen on oppi, joka käsittelee systemaattista prosessien hallitse-mista ja kehittämistä erilaisin menetelmin. Jotta prosesseja voidaan kehittää, ne tulee ensin selvittää, ymmärtää ja analysoida. Yksi merkittävimmistä prosessijohtamisen työ-kaluista, ja lähtökohtana prosessien kehittämiselle, on prosessin nykytilan selvittäminen prosessimallin avulla. Prosessijohtaminen on kasvattanut asemaansa organisaatioiden toiminnassa; sille sekä sen työkaluille on kysyntää erityisesti terveydenhuollossa. Terveydenhuolto-organisaatiot ovat jatkuvan paineen alla tuottaakseen korkealaatui-sia terveydenhuoltopalveluita niukkojen resurssien määräämässä toimintaympäristössä. Modernit terveydenhuollon prosessit ovat tietointensiivisiä ja nojaavat arvonluonnissaan asiantuntijatyöhön yhdistäen monia erilaisia aineellisia ja aineettomia resursseja. Ter-veydenhuollon tulevaisuutta ei taata lisäämällä resurssien määrää vaan muuttamalla sys-teemiä ja suorittamiaan prosesseja, missä olennaisena osana on tukea asiantuntijatyötä tekevien päätöksentekoa. Tutkielma tarjoaa katsauksen sekä prosessijohtamiseen että prosessimallintamiseen ja niiden ominaispiirteisiin terveydenhuollossa. Tutkielmassa esitellään tapaustutkimus Turussa sijaitsevan yksityissairaala Mehiläinen NEO:n magneettikuvausosaston toimin-nasta. Tapaustutkimus pyrkii havainnollistamaan prosessin nykyistä suorituskykyä ja nykytilan selvittämisen sekä prosessimallin ja prosessianalyysin kautta esiin tulevat kehityskohteet. Merkittävin havaittu kehityskohde löytyi ajanvarausjärjestelmästä, joka mahdollistaa kuvauksen keston kannalta tarpeettoman pitkien ajanvarausten suorittamisen, mikä tuot-taa tyhjiä aikavälejä kuvausten välille. Lisäksi prosessissa havaittiin toistuvan tilanne, jossa potilaan vanhojen magneettikuvaustutkimuksien puuttuminen sekä niiden etsimi-nen toimivat haittatekijöinä prosessin kulussa. Empirian aikana järjestetyssä työpajassa nousi esille myös mahdollisuus tarjota potilaalle kuvaukseen liittyvä informaatiopaketti, joka saattaisi helpottaa prosessia asiakkaan näkökulmasta. Vaikka osaston voidaan tode-ta kärsivän lievästä kapasiteettiongelmasta, prosessin havaittiin toimivan muuten tehok-kaasti, esimerkiksi magneettikuvauslaitteen käyttöasteen havaittiin olevan korkeampi kuin kirjallisuuden tarjoamissa esimerkeissä keskimäärin.To ensure organizational development, continuous observation and evaluation of pro-cesses performed is required. Business Process Management (BPM) is a doctrine that deals with systemic management and development of processes. For processes to be de-veloped, an organization must first discover, understand, and analyze them. One of the most prominent tools of BPM and methods to understanding a process is process model-ing. BPM has gained significance in the operations of organizations and demand for BPM and its tools has gained position especially in healthcare. Healthcare organizations are under constant pressure to produce high quality healthcare services in an operational environment controlled by scarce resources. Mod-ern healthcare processes are knowledge intensive, and their value creation relies on the skill level of experts working within the processes. These processes combine several tan-gible and non-tangible assets. The future of healthcare is not secured by increasing the amount of resources but changing the system and its processes. A crucial part in this is supporting the work of experts operating within knowledge intensive processes. This thesis offers an overview on BPM and process modeling and their characteris-tics and position in healthcare. This thesis presents a case analysis of a Magnetic Reso-nance Imaging (MRI) department of a private hospital Mehiläinen NEO located in Tur-ku, Finland. The case aims to demonstrate the current state of the process and via pro-cess modeling and a process analysis the thesis aims to present improvement possibilities within the process. The most prominent improvement target was found in the scheduling system which allowed the reservation of unnecessarily long time slots in relation to the actual length of the MRI. This was proven to generate significant idle time between time slots. In ad-dition, an occurring event was discovered where the lack of a patient’s previous MRI studies and the attempt to acquire them caused disruptions in the process. During a workshop a suggestion came forward in which a patient would be sent an information package regarding information about the upcoming MRI study. The package would aim to ease the process for the patient and aid the process by for example reminding the patient to bring with them the material of possible previous MRI studies. The MRI de-partment at Mehiläinen NEO suffers from a capacity problem at least to some extent. Despite this the process can be seen to work efficiently as for example the occupancy rate of the MRI equipment at Mehiläinen NEO was measured as higher in comparison to other case analyses found in literature

Optimising hospital designs and processes to improve efficiency and enhance the user experience

The health sector is facing increasing pressure to provide effective, efficient, and affordable care to the population it serves. The National Health Service (NHS) of the United Kingdom (UK) has regularly faced scrutiny with NHS England being issued a number of challenges in recent years to improve operational efficiency, reduce wasted space, and cut expenditure. The most recent challenge issued to NHS England has seen a requirement to save £5bn per annum by 2020, while reducing wasted space from 4.4% to 2.5% across the NHS estate. Similarly, satisfaction in the health service is also under scrutiny as staff retention and patient experiences are used in determining the performance of facilities. [Continues.

Incorporating business process management, business ontology and business architecture in medication management quality

Managers and care providers in the health sector are expected to deliver safe, efficient and effective services within a resource constrained, complex system. Services are provided through execution of multiple processes. Healthcare organizations tend to be structured in functional based silos with process improvement efforts often focused on individual processes within the discrete silos. This silo based improvement approach fails to take into account upstream and downstream processes executed and managed in other silos. A patient’s journey will typically include processes from multiple silos and therefore, improvement efforts need to focus on end-to-end processes if the goal is to deliver a positive patient experience. In order to optimize processes in a complex adaptive system like healthcare and to effect meaningful change a combination of management disciplines is required. This research explored the use of Business Process Management (BPM), Business Architecture (BA) and Business Process Management Ontology (BPMO) as a comprehensive, integrated approach to design, redesign, evaluate, improve and monitor the safety, efficiency and effectiveness of medication management processes in a multi-site healthcare organization. The contribution of the research was threefold. First, identified benefits of applying BPM, BPMO and BA to increase organization capacity and improve the end-to-end process of medication management; second, demonstrated the application of an ontology and the business layer of enterprise architecture used in other sectors could be successfully utilized in the healthcare sector; and third, developed a process reference model for medication management processes in acute care and long term care facilities.Business Process ManagementBusiness ArchitectureBusiness Ontologymedication managementquality improvemen

A BPMN-based automated approach for the analysis of healthcare processes

Healthcare organizations are increasingly pushed to improve the quality of care service taking into account the increasing complexity in patient treatment and the continuous reduction of available resources. The adoption of Business Process Management (BPM) practices is thus becoming a key enabler for the improvement of healthcare processes (HPs). Accordingly, methods and tools are required to address behavioral and performance aspects from the early phases of the process lifecycle in order to improve the quality of healthcare, reduce costly reworks and increase the effectiveness of BPM approaches. This paper specifically addresses the specification and analysis phases of the process lifecycle and introduces a model-driven method for healthcare process simulation. The proposed method is based on a model transformation approach that takes as input the process specification in BPMN, appropriately extended to include the performance properties of the process, and yields as output the corresponding process simulation code, ready to be executed. In order to illustrate the method and its effectiveness, the paper describes an example application to a process dealing with the hip fracture for elderly patients